I have been asked a few questions regarding diagnosing Achilles tendonitis or an Achilles tendon tear (depending on the severity). So, in this post I will elaborate on some past posts. Diagnosis is usually done through symptoms and external evaluation. Often there is swelling or inflammation in the area of discomfort, sometimes there will be an actual lump (size can vary). It is tender to the touch or pressure on the area of question. There are certain workouts that you may have found that make it worse such as hills, speed work, plyometrics, or even trail running.
Tendonitis itself won’t show up on an x-ray though it might show a slight thickening in the physical anatomy of the tendon. An x-ray may show the cause however; as is the case with a bone spur pushing against the tendon. A bone spur would be on your heel bone (calcaneous) and therefore, in this case your symptoms would be located in that proximity versus higher up the tendon.
A complete rupture or detachment of the tendon is fairly easy to diagnose; you won’t be able to walk around most likely and your calf will be in a knot. An MRI may show a tear, and it may not. Depending on how long you have suffered from the discomfort will probably depend on whether your doctor will order an MRI. So, tendonitis or a small tear are difficult to confirm through a “test”. And these tests can get expensive. Remember, a test doesn’t make anything better. And most often doesn’t change the course of action (except in the case of a bone spur). I’ve been told it is extremely rare that anything is found pathological in this area such as a tumor or such (which will show up on an x-ray or MRI). So, these tests are used to rule out things more than rule in tendonitis.You make the call.
My advice (see other posts – I’m not a doctor, just a long time Achilles sufferer) is to do the tests you can afford to do.
In the case of bone spurs; they need removal or the tendon will continue to be irritated. A rupture requires surgical reattachment. Surgery in any other case is generally avoided because an invasive procedure can disrupt existing structures and leave scar tissue which could be worse than the original injury.
Otherwise, depending on the severity and duration of your symptoms the usual course will follow like this: rest (don’t run); anti-infammatories, ice regularly; get in the right pair of shoes if and when you can get back to running; replace worn shoes (rule of thumb is 4 months or 400 miles of running); it may then move to a soft cast or walking boot; evaluation for orthotics; rehabilitation (physical therapy) exercises which include core strength as an element to minimze stress on Achilles.